Over the course of the past several decades feminist scholars, in company with medical historians, have developed a sophisticated framework for identifying the ways in which Western medicine, as a system of social control, tends to reproduce and legitimate the construction of gender in the wider society. Wielded by physicians holding positions of power, the notion that “anatomy is destiny” can become a potent ideological weapon, labelling actions that violate “natural law” as unhealthy and their perpetrators as unsound.
For the most part these critical inquiries have not bothered to distinguish biomedicine from alternative healing traditions, the latter having been regarded until recently as a mere fringe phenomenon. But it there is any truth in the notion that these traditions embody not just different treatment modalities, but also more “holistic” approaches to the medical encounter, then it is worthwhile investigating the extent to which they have actually repudiated conventional gender practices. Being rid of stereotype and domination would make these traditions “alternative” in the deepest sense.
At the focus of this paper are the life and works of Dr. James Tyler Kent, an eminent 19-th century American homeopath. Kent himself would never have used the word “alternative” for his personal brand of homeopathy, which he presumed was blessed by God; but with the distance that time affords, we can permit ourselves to use the term as a convenient approximation, recognizing that there was more social overlap and shared ideology linking mainstream with periphery than either sector in those days could allow. In any discussion of 19th-century homeopathy Kent’s name would invariably be mentioned, whether in his role as a brilliant clinician, a prolific writer, or an influential teacher.
Yet Kent, as a privileged male professional, was also thoroughly representative of his own times. Kent articulated a set of beliefs about gender that can be fairly summarized as “androcentric. “1 If confronted (as he may well have been by the female students of his inner circle), Kent would likely have relinquished some of these beliefs as so much cultural debris. But in other instances they appear to be central to the doctor’s worldview, and would therefore have been strongly defended.
Overall, Kent’s homeopathy constitutes but one strand in a wider discursive formation which may be termed “Victorian American;” yet it also departs from its cultural matrix enough to suggest that in his constructions of gender Kent drew upon sources other than popular culture and medical orthodoxy. Assuming this to be so, then a close analysis of Kent’s intellectual career ought to shed light upon the way in which “irregular” physicians positioned themselves at a time when the customary gender roles were undergoing fundamental transformation.
As the theorist most concerned to link the experiences of the body with the long contours of civilization, Michel Foucault necessarily becomes our point of departure. In several of his early works, such as Discipline and Punish and The Birth of the Clinic, Foucault argued that the modern state, with its vastly enhanced powers of surveillance and regulation, is able to exert unprecedented pressure upon people to become just so many “docile bodies.
As one means of enforcing control, the state uses “dividing practices” to label and separate off the insane, the delinquent, the hysteric, and the homosexual. For Foucault, one focus of interest therefore concerns the way in which various civil institutions, such as the prison, the asylum, and the clinic, serve the state in accomplishing its ends. From this perspective the practice of medicine itself becomes problematic, because medicine, though basically noncoercive, possesses formidable technologies that can promote submission to standards which it defines as normative.
With medicine, more than other civic institutions, the normative function is easily dissembled as a concern for the sick, so that in a typical medical encounter both client and practitioner are likely to experience “keenly felt gratifications, which mask elements of ideology and social control that are present on a deeper level” (Waitzkin 1991:41). It can be a complex and delicate matter to identify suppression under such circumstances. In Foucault’s early work there is a totalizing thrust which has justly drawn criticism.
Periodizing history in great blocks of time, his so-called epistemes, Foucault nevertheless tended to restrict his attention to events in Europe, and even then mainly to France. His eurocentrism is thus never more than thinly veiled. Beyond that, with his sweeping assertions about the monolithic state, the panopticon, Foucault in the long run insinuates a sense of defeatism, of disempowerment, which opposes the interests of those subordinate populations about whom he writes (Deveaux 1994).
Responding to these criticisms in later works, such as his History of Sexuality, Foucault succeeded in shifting the focus of analysis away from the formal domain of the state apparatus, towards the everyday world, where power as a constitutive element in social interaction occasions resistance as a matter of course. These two complementary stages2 in Foucault’s intellectual career can serve as a model for research concerned with the place of gender in 19th-century medicine.
Thus, at the macro-political level there are now numerous studies concerning the medical literature of the day, so far as this exercised hegemonic authority with regards to women. A ground-breaking monograph in this regard is Barker-Benfield’s Horrors of the Half-Known Life (1976), which focuses on a cluster of prominent American physicians, who as outspoken misogynists practised sexual surgery and instituted other suppressive methods in order to eradicate various aberrations, including masturbation and lustfulness.
In a similar vein Haller and Haller’s The Physician and Sexuality in Victorian America surveys an immense archive of popular literature, including sex manuals, commercial handbills and other ephemera, as these bear upon the cultural effort to exert strenuous moral regulation over the wayward impulses of both men and women. In America “the sexual politics of health” became an activist issue through a series of works by Barbara Ehrenreich and Deirdre English.
In For Her Own Good (1978) Ehrenreich and English offered a sustained polemic on the subject of male-instituted medical tyranny. Though choosing to stereotype women healers as uniformly feminist in their defiance of orthodoxy, the authors stimulated considerable academic interest in the subject of fringe medicine. The way in which medical authorities “framed” disease categories has been a subject of recent discussion.
Hansen, for example, traces the steps by which homosexuality was labelled as a clinical entity after 1870. This author argues that the medicalization of “inversion” was initially conceived as a humanitarian measure, urged upon the doctors by gay people themselves in some cases; it was not until the 20th-century that this particular diagnosis was to become “a central feature in the social oppression of homosexuals, to the benefit of some members of the medical profession offering ‘cures'” (Hansen 1992: 122).
On the other hand, a fictitious disease entity like “spermatorrhoea” (literally, “sperm in the urine”) proposed by Lallemand at mid-century, was apparently exploited by quacks who were trading on fears that the loss of seminal fluid was injurious to the organism’s spermatic economy overall (Mason 1994: 295-298; Hall 1992). 3 Finally, in the instance of such supposed women’s diseases as “kleptomania” and “nymphomania” we encounter strong evidence of misogynist labeling practices.
In the case of kleptomania a stratum of privileged middle-class pilferers was defined on medical grounds as being impervious to the law. The diagnosis of kleptomania was an act of contemptuous patronage, in which the perpetrators themselves colluded (O’Brien 1983; Adelson 1989). More serious, however, was the diagnosis of nymphomania, for that could make a lesbian or sexually expressive woman vulnerable to corrective procedures such as clitoridectomy or cauterization (Groneman 1994).
In some instances medical problems were made subject to hegemonic control through technological innovations. Erin O’Connor, for instance, discusses the role of medical photography in helping consolidate anorexia nervosa as a modern disease entity in the 19-th century. The photographic image, by substituting a visual message for a psychiatric discussion, underscored the tendency to think of anorexia as being “confined to the surface of the body,” such that “problems of subjectivity simply did not matter next to the stark fact of starvation” (O’Connor 1995: 549;555).
Through the use of before-and-after images, where the wasting girls dramatically recovered their fleshy womanhood, a 19-century physician like William Gull could provide an indubitable record of the anorexic’s return to health under a regimen of force-feeding, without having to consider her illness as an “idiom of distress – a somatic response to everyday life” (Parsons and Wakeley 1991).
Due in part to the lack of recorded information, there are fewer historical studies that treat the medical encounter as a negotiated reality, let alone a contested ground where the physician’s power to define and normalize is clearly resisted by the patient. As Kuipers notes, “[i]nnovative, sensitive, and careful interpretations of archival and contemporary texts that historically and philologically situate the speaking practices of medical professionals have only just begun” (Kuipers 1989: 105). Several landmark studies have nevertheless established a framework by which Victorian medicine can be understood as a contested discourse.
In her discussion of the interaction between doctors and hysterics, Carroll Smith-Rosenberg speculates in psychodynamic terms that the hysteric, functioning in the passive-aggressive mode, occasioned a punitive response on the part of many doctors, who “felt themselves to be locked in a power struggle” with women whose greatest victory was their continued illness (Smith-Rosenberg 1972: 674). In a joint paper with her husband, Smith- Rosenberg went on to analyze the conservative medical discourse regarding contraception and abortion, which opened up “access for women to new roles and a new autonomy.
Responding with increasing harshness, many male doctors decried such practices as “unnatural, their hostility, rancour and moral outrage being a reliable measure of the fundamental cultural tension” which they were experiencing (Smith-Rosenberg and Rosenberg 1973: 350;354). Similarly, Ann Wood maintained that in Victorian Ameriaca “a complicated if unacknowledged psychological warfare was being waged between the doctors and their patients” (Wood 1973: 33), resulting in medical diagnoses that were shot full of distrust and condemnation.
While one can only conjecture what the majority of female patients thought about all this, Wood analyses the writings of a small group of feminist hygiene experts and lady doctors, who with “a masked but almost hysterical paranoia” recognized in the medical practices of the day “as a form of rape. ” The women doctors who began appearing in the 1850s regarded women’s diseases as “a result of submission, and promoted independence from masculine domination, whether professional or sexual, as their cure for feminine ailments” (Wood 1973: 33;40;44).
Because it generalizes the interactionist approach to the level of broad cultural processes, Edward Shorter’s From Paralysis to Fatigue is a work worth reviewing in some detail. Shorter offers some sly, even comic insights into the dynamics of psychosomatic illness. In his negotiation model, a population of “somatizing” patients draws upon a culturally approved “symptom pool” in striving to fashion an illness which their doctors will agree to authenticate.
In the course of these doctor/patient negotiations, some psychosomatic complexes receive the coveted designation of disease, whereas others are refused medical sanction. Not wanting to make itself look ridiculous, the unconscious “brings itself medically up to date,” periodically spawning new symptomatologies to keep abreast of technology and changing perceptions. When generalized to the cultural level, these negotiations produce a situation of pathoplasticity, meaning “the tendency of illness attribution and presentation to change with fashion.
According to Shorter, “the volume of perceived aches, pains, and weariness has probably changed little historically. What changes is people’s readiness to seek medical help for these symptoms, to define them as disease, and to give them fixed attributions. ” Beginning with spinal irritation, the first modern instance of a cultural shaping of patients’ symptoms,”5 Shorter traces the rise and fall of many other pseudoneurophysiological conditions which patients, in unconscious collusion with their doctors, bargained into existence.
He argues that if the nineteenth century was the century of motor hysteria, especially among young women, then the late twentieth century is one of sensory afflictions, including such recent contenders as “fibromyalgia,” “TMJ syndrome,” and “chronic fatigue syndrome” (Shorter 1992: 54;266;12). Coming at last full circle, Margaret Pelling claims that the time is now ripe to draw attention to the opposite tendency, that is, the process by which women, as mothers, sisters and wives, exercised formative influences on male doctors throughout the course of their careers.
Observing that medicine is “an occupation that is unusual in the depth to which it penetrates the domestic settings of other families,” Pelling proposes that male physicians, feeling overwhelmed, chose to compensate for their constant immersion in the world of women by distancing themselves “from the bodies of their patients. ” Nevertheless, Pelling interprets the available evidence from Britain as indicating that “the female line of influence in ‘medical families’ might be stronger than the male,” even if under patriarchal cover it was far less visible (Pelling 1995: 386-7;397).
Pelling’s research is consistent with that of Shawn Johansen, who disputes the notion that the public and private spheres were rigidly dichotomized along gender lines. While men and women in the nineteenth-century were indeed kept apart in many ways, these gender conventions broke down in times of health crises and childbirth, where men as well as women had a role to play (Johansen 1995: 184). Rejecting altogether the victim’s perspective, a group of studies, as yet few in number, have concerned themselves with the distinctive career paths mapped by women practitioners.
In the context of the 18th-century often the only information that can be retrieved about such women takes the form of printed advertisements in archived newspapers and handbills (Crawford 1984); however, with regards to the following century feminist scholars are finding the data to be surprisingly rich. Drawing upon documents surrounding a sensational libel trial held in 1892, Regina Morantz-Sanchez has been able to reconstruct the career choices of Dr. Mary Amanda Dixon Jones, a gynaecological surgeon, who attained prominence in a specialty that had been hitherto restricted to men.
Dr. Jones initially followed a trajectory amenable to other women physicians at mid-century, ensconcing her activities within a “medical subculture of seminaries, sectarian colleges, and professional networks that was predominantly female. ” However, her decision to pursue orthodox training directly challenged this pattern; and her subsequent rise to the top, with all the problems involved in negotiating a personal identity, made Dr. Jones “the nineteenth-century version of the ‘difficult woman'” (Morantz-Sanchez 1995: 216).
Until recently “all but invisible to historians” (Rogers 1990: 282), the world of sectarian medicine (a term without religious implications, indicating only that the practitioners pursued a single, exclusive healing modality) is proving a fertile ground for research on women’s struggle for autonomy and professional standing. Generally enforcing an open admissions policy, the sectarian colleges played an important role for women seeking medical training throughout the 19th-century (Rogers 1990: 293).
That this was a significant avenue of access for women is suggested in the fact that by the time of the Flexner Report in 1910, the New York Homeopathic Women’s Medical College and Hospital was the second last women’s medical school operating in all of America (Rogers 1990: 309). Within the sectarian milieu there also seems to have been a close relationship between professionals, health reformers, and women’s rights advocates. Less class-conscious than their orthodox counterparts, the sectarian practitioners apparently devoted a large portion to their practice to serving the poor.
Julia Minerva Green, a Washington homeopath, maintained a practice in which one-quarter of her patients were charity cases (Moldow 1987: 128). A long-time director of the American Foundation for Homeopathy, Dr. Green is said to have made housecalls on a bicycle, her skirt held down by lead weights sewn into the hem (Nielson 1997: 34). All of these research initiatives, whether hegemonic or interactionist, help shed light upon the construction of gender within the field of sectarian medicine.
Yet in the final analysis they fail to explain how it was possible for male sectarians to maintain ideologies of male dominance within such a radical milieu, right in the face of their female collegues. Certainly in the case of homeopathy, for all its opposition to medical orthodoxy, the record is larded with instances of androcentrism, and even chauvinism, where gender equality was denied in the interests of social control. Though it is tempting to pile up examples, one particularly cloying (because late-blooming? ) text will serve to represent the tendency overall.
In a paper read before the International Hahnemannian Association in 1929 – published incidentally in the same volume with a case study by Dr. Julia Green – Irving L. Farr M. D. observes in connection with the Biblical injunction to be fruitful and multiply that when misdirected the power of procreation can wreck homes and even cause the downfall of nations, “as history teaches. ” He goes on to claim that the likes of Professor Sigmund Freud has convinced large numbers of psychology students that “the mental upsets, seen at the menopause, occur more often in those women who have been denied motherhood, from whatever cause.
Therefore, Dr. Farr concludes that in these days of “loose morals among the youth,” the family physician has “a field for rearing and developing his prospective mothers,” who dread child-bearing “as though it were a disease. ” Against this background Dr. Farr envisions the family doctor becoming the friend and instructor of the child, gaining her confidence, so that she comes to him with all her curiosity as to what life is and how it happens.
She comes to him to learn from him that wonderful knowledge, which he possesses, the solution of the growing urge within her and what it portends; to learn what puberty and menstruation are designed for, and why she changes in her attitude, as the years pass… Thus the first confinement is not to be The End of the Honeymoon Trail, but the culmination of a series of regular progressions, from her own babyhood to her own baby, with her hand constantly within the hand of her life-long doctor-friend, her obstetrician (Farr 1929: 792-4).
With the benefits of hindsight it would not be difficult to leaf through the yellowing journals, culling all the ludicrous blunders and clumsy social control tactics which forgotten doctors committed to print. Yet such a procedure would be merely churlish – and worse, self-blinding – in connection with a healer of Kent’s stature. As with Freud’s failure in the case of Dora (see above, Fn 4), “even the shrewdest therapist’s perspicacity may desert him when it comes into conflict with his milieu and his society” (Lakoff and Coyne 1993:92).
Thus, in the case of a figure who commands our respect across the span of years, it is important to distinguish those domains in which he was markedly innovative, from those in which he merely gave voice to the ideology of his time. In Kent’s case there were two domains in particular where he seemed very much the Victorian American doctor. For one thing, the manner in which he practised as a homeopath does not seem to have departed much from the androcentric model of the physician as this was generally defined in the nineteenth century.
Kent’s homeopathic “philosophy,” so profoundly influenced by Swedenborg, was likewise imbued with backward-looking androcentric values. On the other hand, in several other domains Kent’s form of homeopathy either contested the contemporary constructions of gender, or else brought them into glaring relief. For one thing, his opposition to the conventional disease categories, for instance, helped demystify certain gender conditions, such as hysteria and chlorosis, which we would nowadays classify as psychosomatic illnesses.
A more important contribution, however, was his elaboration of a series of gender-inflected remedy pictures. As a subset within his Lectures on Homoeopathic Materia Medica, these remedy pictures comprise a virtual album of the manifold sexual miseries that were endured in Victorian American. In some instances Kent’s portraits have thankfully faded with the passage of years; but in others the features are still sharp. In spite of their sepia tones they can still affect us today, fresh as ever, like aromatic herbs pressed into the pages of the text.
